Blood at aspiration

[IronMonkey69]

i pulled some blood when i aspirated but injected it anyways... is this bad?

[uckmo]

It not the best idea but how did you feel afterwards?I take it your doing fine.

[IronMonkey69]

i feel fine.. i bled a lil more than usual but thats about it. i just put a band aid on it... is that really bad?

[Arnold jr]

If you're going to aspirate, and you pull out blood, why on earth would you go ahead and inject? Kind of defeats the purpose.

[trab]

Dude, the whole point is to NOT PUT THE STUFF IV!!
If you asperate SLOW & SMOTH you'll see the blood before it gets out of the little plastic hub where it screws to the hypo barrel - STOP! Replace pin, repoke!

[busyB]

i pulled some blood when i aspirated but injected it anyways... is this bad?

wow....now, did we not read someplace when we were first thinking of doing a cycle that maybe that was a bad idea..

things that make you go hhhmmmm 

[freakfestMD]

i pulled some blood when i aspirated but injected it anyways... is this bad?

This depends on how much blood. 

If you truly cannulate a vessel with your needle, the syringe will fill quickly with a large amount of blood as you pull back on the plunger.  In this case, I would remove the needle and hold pressure for a few minutes, then pick a different site.

Sometimes a little speck of blood enters the hub of the needle itself as you go in.  This is usually from a slower more traumatic stick (like your hand is shaking from inexperience) and is due to small vessel/capillary rupture and shouldn't be a big deal.  Once you've achieved your desired needle depth, then pull back on the syringe.  In these cases usually no further significant blood enters the syringe and you should be OK to inject.

[Luv2Hurt]

Yep good points Freak.  You will know when you are in a vein, cause that thing will fill up with blood in about 1 second.  I have had it happen a couple times.  I just squirted out as much of the blood as I could and re-poked.

Freak is it important not to re-inject the blood if a substantial amount enters the syringe?  Freak whats it like to shove a huge spike into someones spinal canal?

[freakfestMD]

Freak is it important not to re-inject the blood if a substantial amount enters the syringe?  Freak whats it like to shove a huge spike into someones spinal canal?

I can't give you an exact answer on the first question.  I would'nt suggest aspirating too much blood into the syringe in the first place.  It shouldn't take much for you to know you've cannulated a vessel.  It would be hard, I think, to squirt out the blood without wasting alot of your gear .  At the same time, I wouldn't re-inject more than 1 or 2 cc's of blood back into a different site along with your gear as that would be basically like injecting into a hematoma, and collected blood LOVES to get infected.

As far as the second question, I don't have to do many epidural catheters, but it's no big deal.  You feel the spinal needle pop through the ligamentum flavum and then there's an immediate rush of clear spinal fluid.  As an orthopaedic surgeon focusing mainly on severe spinal deformities in children, I try to stay the hell out of the spinal canal as much as I can.  I can tell you this, though, that putting pedicle screws in the vertebrae and taking a horrible spinal curve and making it straight is the freaking bomb!

[trab]

Thanks for the med class Freak, a straight kids spine sounds like very  rewarding work bud.
How the hell you bring yourself to do somthing like that the first few times? Scared shitless?

[clayton green]

Freak,

Is it best to inject a site slowly or fast?  I usually go slow on the quads and buttocks (my hangup)and fast on my delts and traps.  On several occasions, when I have finished injecting and ready to pull out I notice a little blood in the hub of the needle.  When this happens, usually the injection site bleeds a little more than other injection sites.

I inject high and to the outside of the buttocks but was wondering if it is okay to go a little bit in towards the center of the buttocks and perhaps a little lower.  It's a big site and I feel that I am only using a 1-2" diameter on either side.

Thanks

[Rimbaud]

Freak,

Is it best to inject a site slowly or fast?  I usually go slow on the quads and buttocks (my hangup)and fast on my delts and traps.  On several occasions, when I have finished injecting and ready to pull out I notice a little blood in the hub of the needle.  When this happens, usually the injection site bleeds a little more than other injection sites.

I inject high and to the outside of the buttocks but was wondering if it is okay to go a little bit in towards the center of the buttocks and perhaps a little lower.  It's a big site and I feel that I am only using a 1-2" diameter on either side.

Thanks

IMO - just nice slow & steady pressure.

[Overload]

IMO - just nice slow & steady pressure.

I concur...

My injections take over a minute. Nice and slow.

[busyB]

Freak,

Is it best to inject a site slowly or fast?  I usually go slow on the quads and buttocks (my hangup)and fast on my delts and traps.  On several occasions, when I have finished injecting and ready to pull out I notice a little blood in the hub of the needle.  When this happens, usually the injection site bleeds a little more than other injection sites.

I inject high and to the outside of the buttocks but was wondering if it is okay to go a little bit in towards the center of the buttocks and perhaps a little lower.  It's a big site and I feel that I am only using a 1-2" diameter on either side.

Thanks

Just watch out for the sciata (sp?) nerve towards the mid to lower end of your ass..
anyone??

[clayton green]

I am not sure I asked the question the correct way.  I was referring to the actual insertion of the needle.  Should it be relatively fast or slow?

Once the needle is inserted, I always go slow. Most of the time I don't have a choice as I use a 25 gauge, which will not permit me to inject fast.  

Thanks

[freakfestMD]

I am not sure I asked the question the correct way.  I was referring to the actual insertion of the needle.  Should it be relatively fast or slow?


Thanks

Speed of insertion of the needle doesn't really matter.  I just think it hurts less the faster you sink it.

Must say, though, that I don't find any of the injections to be painful at all.  It's that damn 24 to 48 hours later!

[freakfestMD]

Just watch out for the sciata (sp?) nerve towards the mid to lower end of your ass..
anyone??

The sciatic nerve exits very low in the glute.  Shouldn't be a problem.  Most guys could never reach around far enough to ever hit it. 

More importantly, the superior gluteal artery can be lacerated.  It exits the sciatic notch just like the sciatic nerve, but then it courses cephalad (upwards) as opposed to the sciatic nerve which travels caudad (downwards).  That artery is potentially a BIG problem for me during exposures of the pelvis during spine cases--if it is injured, it can retract into the abdomen and the patient would need to be flipped over immediately for an abdominal approach to locate it and ligate it.  If you hit that artery during an injection, be prepared for a very large hematoma...

Suffice it to say that for glutes, best to stay in the upper outer quadrant.

[trab]

I dont know about Humans, but the speed a Deer bleeds out when hit w/ a razor head in the femoral artery is FAST! They drop in a couple minutes max.

[SWOLETRAIN]

Heres a question for the Md,
 When i hit a lateral injection on the quad, aspirate, all is well and inject. What is the reason for a sudden gush of blood when the pin is removed. Has happened now and then, just curious. In this case does the gear still make it in?

[busyB]

The sciatic nerve exits very low in the glute.  Shouldn't be a problem.  Most guys could never reach around far enough to ever hit it. 

More importantly, the superior gluteal artery can be lacerated.  It exits the sciatic notch just like the sciatic nerve, but then it courses cephalad (upwards) as opposed to the sciatic nerve which travels caudad (downwards).  That artery is potentially a BIG problem for me during exposures of the pelvis during spine cases--if it is injured, it can retract into the abdomen and the patient would need to be flipped over immediately for an abdominal approach to locate it and ligate it.  If you hit that artery during an injection, be prepared for a very large hematoma...

Suffice it to say that for glutes, best to stay in the upper outer quadrant.

Whew, good thing I did not go to med school! 

Thanks for the clearification Doc, that is actually the artery I was referring to as I read the same thing you said somewhere before.

[clayton green]

Heres a question for the Md,
 When i hit a lateral injection on the quad, aspirate, all is well and inject. What is the reason for a sudden gush of blood when the pin is removed. Has happened now and then, just curious. In this case does the gear still make it in?

I had posted the same question to freak earlier in this  thread.  The same thing happens to me in my quad as well.  IMO, the gear does get into the muscle but I do not know what causes the blood to get into the hub of the needle after injection.

Another questions for Freak, from the outer quadrant of the glutes how far inward (inches) and down (inches) can a person inject withh cause for alarm.

[thewickedtruth]

This depends on how much blood. 

If you truly cannulate a vessel with your needle, the syringe will fill quickly with a large amount of blood as you pull back on the plunger.  In this case, I would remove the needle and hold pressure for a few minutes, then pick a different site.

Sometimes a little speck of blood enters the hub of the needle itself as you go in.  This is usually from a slower more traumatic stick (like your hand is shaking from inexperience) and is due to small vessel/capillary rupture and shouldn't be a big deal.  Once you've achieved your desired needle depth, then pull back on the syringe.  In these cases usually no further significant blood enters the syringe and you should be OK to inject.

I was fixing to say, unless it's some decent amount of volume, you more than likely lanced something on the way in. Any sort of blood volume in the barrel after the aspiration and just like freak said, you're probably laying it in the pipe.

[sgt. d]

That Division guy says it is best to inject as fast as you can. He said its best to throw the needle in like a dart and dont aspirate.


^Yeah sure

[freakfestMD]

Heres a question for the Md,
 When i hit a lateral injection on the quad, aspirate, all is well and inject. What is the reason for a sudden gush of blood when the pin is removed. Has happened now and then, just curious. In this case does the gear still make it in?

I've had this happen as well.  Again, I think this is from the needle piercing smaller vessels upon entry.  The volume injected also increases the local pressure,  This probably accounts for that sometimes unexpected gush of blood.  Most of the gear should stay in, but I'm sure at least a little comes out.  I always have a fresh gauze pad opened and ready and cover the site and apply pressure immediately after withdrawl.

[freakfestMD]

IAnother questions for Freak, from the outer quadrant of the glutes how far inward (inches) and down (inches) can a person inject withh cause for alarm.

Lateral thigh is a safe spot pretty much all the way down to the bottom of the vastus lateralis.  You can hit a lateral perforator at around 4-6 inches below the vastus ridge (the indentation just below the greater trochanter at the top of the femur) which could cause some bleeding.

As far as safety more medially, I would not suggest going more medial than an imaginary line drawn straight down from the anterior superior iliac spine (ASIS).  You run the risk of hitting the lateral femoral cutaneous nerve of the thigh, which can hurt like hell and cause numbness to the upper later thigh.  More medial to this, you could hit the femoral artery or vein, but you'd have to be way medial for this.  Just feel for your own pulse up in the groin to give you an idea of how medial this big sucker is.

I think the easiest of all injections is the vastus medialis (the "teardrop") down by the knee.  You can pin it in a sitting position, too.  This is the spot I was pinning once under my desk when my secretary walked right into my office.  There I am with my pants down and the pin sticking straight out of my thigh.  She put something on my desk and just walked right out!  Anyway, the first time you do this one, be prepared for some serious pain at the 24-48 hour mark, but once you get used to it it's a breeze.